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Facilitators of and barriers to reducing thirty-day readmissions and improving patient-reported outcomes after surgical aortic valve replacement: a process evaluation of the AVRre trial
BMC Health Services Research ( IF 2.8 ) Pub Date : 2020-03-27 , DOI: 10.1186/s12913-020-05125-5 Stein Ove Danielsen 1, 2, 3, 4 , Philip Moons 3, 5, 6 , Marit Leegaard 4 , Svein Solheim 7 , Theis Tønnessen 2, 8 , Irene Lie 1
BMC Health Services Research ( IF 2.8 ) Pub Date : 2020-03-27 , DOI: 10.1186/s12913-020-05125-5 Stein Ove Danielsen 1, 2, 3, 4 , Philip Moons 3, 5, 6 , Marit Leegaard 4 , Svein Solheim 7 , Theis Tønnessen 2, 8 , Irene Lie 1
Affiliation
The Aortic Valve Replacement Readmission (AVRre) randomized control trial tested whether a telephone intervention would reduce hospital readmissions following surgical aortic valve replacement (SAVR). The telephone support provided 30 days of continuous phone-support (hotline) and two scheduled phone-calls from the hospital after discharge. The intervention had no effect on reducing 30-day all-cause readmission rate (30-DACR) but did reduce participants’ anxiety compared to a control group receiving usual care. Depression and participant-reported health state were unaffected by the intervention. To better understand these outcomes, we conducted a process evaluation of the AVRre trial to gain insight into the (1) the dose and fidelity of the intervention, (2) mechanism of impacts, and (3) contextual factors that may have influenced the outcomes. The process evaluation was informed by the Medical Research Council framework, a widely used set of guidelines for evaluating complex interventions. A mix of quantitative (questionnaire and journal records) and qualitative data (field notes, memos, registration forms, questionnaire) was prospectively collected, and retrospective interviews were conducted. We performed descriptive analyses of the quantitative data. Content analyses, assisted by NVivo, were performed to evaluate qualitative data. The nurses who were serving the 24/7 hotline intervention desired to receive more preparation before intervention implementation. SAVR patient participants were highly satisfied with the telephone intervention (58%), felt safe (86%), and trusted having the option of calling in for support (91%). The support for the telephone hotline staff was perceived as a facilitator of the intervention implementation. Content analyses revealed themes: “gap in the care continuum,” “need for individualized care,” and “need for easy access to health information” after SAVR. Differences in local hospital discharge management practices influenced the 30-DACR incidence. The prospective follow-up of the hotline service during the trial facilitated implementation of the intervention, contributing to high participant satisfaction and likely reduced their anxiety after SAVR. Perceived less-than-optimal preparations for the hotline could be a barrier to AVRre trial implementation. Integrating user experiences into a mixed-methods evaluation of clinical trials is important for broadening understanding of trial outcomes, the mechanism of impact, and contextual factors that influence clinical trials. ClinicalTrials.gov, NCT02522663. Registered on 11 August 2015.
中文翻译:
减少主动脉瓣置换术后三十天再入院和改善患者报告结果的促进因素和障碍:AVRre 试验的过程评估
主动脉瓣置换术再入院 (AVRre) 随机对照试验测试了电话干预是否会减少主动脉瓣置换术 (SAVR) 后的再入院率。电话支持提供 30 天的连续电话支持(热线)和出院后医院的两次预定电话。该干预措施对降低 30 天全因再入院率 (30-DACR) 没有影响,但与接受常规护理的对照组相比,确实降低了参与者的焦虑程度。抑郁症和参与者报告的健康状况未受到干预的影响。为了更好地了解这些结果,我们对 AVRre 试验进行了过程评估,以深入了解 (1) 干预的剂量和保真度,(2) 影响机制,以及 (3) 可能影响结果的背景因素。过程评估以医学研究委员会框架为基础,这是一套广泛使用的评估复杂干预措施的指南。前瞻性地收集定量(调查问卷和日记记录)和定性数据(现场笔记、备忘录、登记表、调查问卷),并进行回顾性访谈。我们对定量数据进行了描述性分析。在 NVivo 的协助下进行内容分析以评估定性数据。提供 24/7 热线干预服务的护士希望在干预实施之前得到更多的准备。SAVR 患者参与者对电话干预非常满意 (58%),感到安全 (86%),并且相信可以选择致电寻求支持 (91%)。对电话热线工作人员的支持被认为是干预措施实施的促进因素。内容分析揭示了以下主题:SAVR 后“护理连续性的差距”、“个性化护理的需求”以及“轻松获取健康信息的需求”。当地出院管理实践的差异影响了 30-DACR 的发生率。试验期间热线服务的前瞻性随访促进了干预措施的实施,有助于提高参与者的满意度,并可能减少他们在 SAVR 后的焦虑。人们认为热线准备工作不够理想可能会成为 AVRre 试验实施的障碍。将用户体验整合到临床试验的混合方法评估中对于扩大对试验结果、影响机制以及影响临床试验的背景因素的理解非常重要。ClinicalTrials.gov,NCT02522663。2015年8月11日注册。
更新日期:2020-03-27
中文翻译:
减少主动脉瓣置换术后三十天再入院和改善患者报告结果的促进因素和障碍:AVRre 试验的过程评估
主动脉瓣置换术再入院 (AVRre) 随机对照试验测试了电话干预是否会减少主动脉瓣置换术 (SAVR) 后的再入院率。电话支持提供 30 天的连续电话支持(热线)和出院后医院的两次预定电话。该干预措施对降低 30 天全因再入院率 (30-DACR) 没有影响,但与接受常规护理的对照组相比,确实降低了参与者的焦虑程度。抑郁症和参与者报告的健康状况未受到干预的影响。为了更好地了解这些结果,我们对 AVRre 试验进行了过程评估,以深入了解 (1) 干预的剂量和保真度,(2) 影响机制,以及 (3) 可能影响结果的背景因素。过程评估以医学研究委员会框架为基础,这是一套广泛使用的评估复杂干预措施的指南。前瞻性地收集定量(调查问卷和日记记录)和定性数据(现场笔记、备忘录、登记表、调查问卷),并进行回顾性访谈。我们对定量数据进行了描述性分析。在 NVivo 的协助下进行内容分析以评估定性数据。提供 24/7 热线干预服务的护士希望在干预实施之前得到更多的准备。SAVR 患者参与者对电话干预非常满意 (58%),感到安全 (86%),并且相信可以选择致电寻求支持 (91%)。对电话热线工作人员的支持被认为是干预措施实施的促进因素。内容分析揭示了以下主题:SAVR 后“护理连续性的差距”、“个性化护理的需求”以及“轻松获取健康信息的需求”。当地出院管理实践的差异影响了 30-DACR 的发生率。试验期间热线服务的前瞻性随访促进了干预措施的实施,有助于提高参与者的满意度,并可能减少他们在 SAVR 后的焦虑。人们认为热线准备工作不够理想可能会成为 AVRre 试验实施的障碍。将用户体验整合到临床试验的混合方法评估中对于扩大对试验结果、影响机制以及影响临床试验的背景因素的理解非常重要。ClinicalTrials.gov,NCT02522663。2015年8月11日注册。